
Contents
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Diabetes mellitus Diabetes mellitus
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General considerations General considerations
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Preoperative assessment Preoperative assessment
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Investigations Investigations
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Preoperative management Preoperative management
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Perioperative management Perioperative management
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Hypoglycaemia Hypoglycaemia
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Intravenous insulin/glucose regime Intravenous insulin/glucose regime
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QDS SC insulin regime QDS SC insulin regime
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ITU admissions ITU admissions
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Glucose potassium insulin regime (GKI or Alberti) Glucose potassium insulin regime (GKI or Alberti)
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Further reading Further reading
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Acromegaly Acromegaly
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Preoperative assessment Preoperative assessment
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Investigations Investigations
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Conduct of anaesthesia Conduct of anaesthesia
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Postoperative care Postoperative care
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Further reading Further reading
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Thyroid disease Thyroid disease
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General considerations for non-thyroid surgery General considerations for non-thyroid surgery
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Hypothyroidism Hypothyroidism
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Hyperthyroidism (thyrotoxicosis) Hyperthyroidism (thyrotoxicosis)
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Preoperative assessment Preoperative assessment
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Investigations Investigations
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Conduct of anaesthesia Conduct of anaesthesia
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Hypothyroid patients Hypothyroid patients
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Hyperthyroid patients Hyperthyroid patients
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Special considerations Special considerations
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Thyroid storm Thyroid storm
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Hypothyroid coma Hypothyroid coma
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Further reading Further reading
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Parathyroid disorders Parathyroid disorders
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General considerations General considerations
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Hyperparathyroidism Hyperparathyroidism
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Hypercalcaemic crisis Hypercalcaemic crisis
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Secondary hyperparathyroidism Secondary hyperparathyroidism
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Tertiary hyperparathyroidism Tertiary hyperparathyroidism
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Perioperative plan Perioperative plan
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Hypoparathyroidism Hypoparathyroidism
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Further reading Further reading
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Adrenocortical insufficiency Adrenocortical insufficiency
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Primary (Addison's disease) Primary (Addison's disease)
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Secondary Secondary
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Acute adrenal crisis Acute adrenal crisis
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Clinical features of chronic adrenal insufficiency Clinical features of chronic adrenal insufficiency
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Investigations Investigations
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Treatment Treatment
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Perioperative management of patients with long-standing Addison's disease Perioperative management of patients with long-standing Addison's disease
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Adrenal crisis (Addisonian crisis) Adrenal crisis (Addisonian crisis)
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Relative adrenal insufficiency in the critically ill Relative adrenal insufficiency in the critically ill
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Further reading Further reading
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The patient on steroids The patient on steroids
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HPA suppression HPA suppression
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Further reading Further reading
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Cushing's syndrome Cushing's syndrome
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Clinical features Clinical features
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Diagnosis Diagnosis
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Preoperative assessment Preoperative assessment
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Conduct of anaesthesia Conduct of anaesthesia
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Further reading Further reading
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Conn's syndrome Conn's syndrome
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General considerations General considerations
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Clinical features Clinical features
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Preoperative assessment for adrenalectomy Preoperative assessment for adrenalectomy
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Investigations Investigations
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Conduct of anaesthesia for adrenalectomy Conduct of anaesthesia for adrenalectomy
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Postoperative care Postoperative care
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Management of patients with Conn's syndrome for non-adrenal surgery Management of patients with Conn's syndrome for non-adrenal surgery
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Further reading Further reading
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Apudomas Apudomas
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Phaeochromocytoma Phaeochromocytoma
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Carcinoid tumours Carcinoid tumours
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Carcinoid syndrome Carcinoid syndrome
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Preoperative assessment Preoperative assessment
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Investigations Investigations
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Conduct of anaesthesia Conduct of anaesthesia
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Postoperative Postoperative
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Gastrinoma Gastrinoma
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VIPoma VIPoma
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Insulinoma Insulinoma
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Glucagonoma Glucagonoma
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Further reading Further reading
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Hypokalaemia Hypokalaemia
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Causes Causes
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Clinical manifestations Clinical manifestations
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Management Management
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Anaesthetic considerations Anaesthetic considerations
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Further reading Further reading
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Hyperkalaemia Hyperkalaemia
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Causes Causes
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Clinical manifestations Clinical manifestations
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Management Management
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Anaesthetic considerations Anaesthetic considerations
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Further reading Further reading
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Hyponatraemia Hyponatraemia
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Presentation Presentation
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Treatment of symptomatic hyponatraemia Treatment of symptomatic hyponatraemia
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Asymptomatic hyponatraemia (often chronic) Asymptomatic hyponatraemia (often chronic)
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Anaesthetic implications Anaesthetic implications
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Hypernatraemia Hypernatraemia
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Presentation Presentation
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Management Management
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Anaesthetic implications Anaesthetic implications
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Further reading Further reading
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Obesity Obesity
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Cardiovascular Cardiovascular
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Respiratory Respiratory
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Gastrointestinal Gastrointestinal
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Endocrine Endocrine
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General General
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Pharmacokinetics/dynamics Pharmacokinetics/dynamics
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Preoperative assessment Preoperative assessment
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Preoperative investigations Preoperative investigations
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Conduct of anaesthesia Conduct of anaesthesia
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Postoperative care Postoperative care
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Further reading Further reading
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8 Endocrine and metabolic disease
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Published:July 2011
Cite
Extract
Diabetes mellitus
Insulin is necessary, even when fasting, to maintain glucose homeostasis and balance stress hormones (e.g. adrenaline). It has two classes of action:
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Lack of insulin is associated with hyperglycaemia, osmotic diuresis, dehydration, hyperosmolarity, hyperviscosity predisposing to thrombosis, and increased rates of wound infection. Sustained hyperglycaemia is associated with increased mortality, hospital stay, and complication rates.
Diabetes mellitus is present in 5% of the population.
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General considerations
Many diabetic patients are well informed about their condition and have undergone previous surgery. Discuss management with them. Hospital diabetic teams can be useful for advice. The overall aims of perioperative diabetic management are to maintain physiological glucose levels (above hypoglycaemic levels, but below those at which deleterious effects of hyperglycaemia become evident) and prevent hypokalaemia, hypomagnesaemia, and hypophosphataemia.
Preoperative assessment
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Investigations
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Preoperative management
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Perioperative management
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Hypoglycaemia
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Intravenous insulin/glucose regime
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QDS SC insulin regime
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